Unusual electrocardiographic manifestations in conditions with increased intrathoracic pressure.

Clinical, electrocardiographic and haemodynamic findings of 10 patients suffering from intrathoracic conditions were analyzed. Three patients suffering from left spontaneous pneumothorax, three from large left pleural effusion, three from traumatic rupture of the left diaphragm and one from sliding hiatus hernia were found to have electrocardiographic alternation, while their central venous pressure and pulmonary capillary wedge pressure were increased. With the correction of the condition the electrocardiographic alternation disappeared and the pressures returned to normal. The increase in direct or indirect pressure exerted on the global surface of the heart, as it is reflected in pulmonary capillary and venous pressures, seems to be the cause of the electrical alternation observed in these patients.

Comparison of echocardiography and radiology in the diagnosis of aortic root dilatation in Marfan's syndrome and in syphilis.

Aortic root dilatation was sought by echocardiography and radiology in 500 consecutive patients referred to an echocardiography laboratory from cardiac or medical clinics and wards. Forty-four of these patients (8.8%) had false echocardiographic evidence of aortic root dissection, but no clinical evidence of the disease. These false findings were attributed to the changing of the transducer angulation, post-stenotic dilatation, calcific aortic stenosis, generalised arteriosclerosis, and thin reverberations behind the posterior wall echo. In one patient with Marfan's syndrome, the chest radiograph was normal and a diagnosis was established by echocardiography. In another patient with syphilis, the dilatation was seen in the chest radiograph while echocardiography revealed a normal proximal aorta. In syphilis the dilatation begins distally and because of the intervening lung tissue echocardiography is unhelpful. Echocardiograms easily detect the aortic valve ring while radiographs show the more distal ascending aorta. These observations may be of added value in the diagnosis of aortic root disease.

Pulmonary function in coal workers with Caplan's syndrome and non-rheumatoid complicated pneumosoniosis.

This retrospective study compares the pulmonary function of 24 coal workers with Caplan's syndrome with that of 36 subjects with non-rheumatoid progressive massive fibrosis (PMF). Allowing for differences in radiographical category, age, years worked underground, and smoking, obstruction to air flow as reflected in the one-second forced expiratory volume, the vital capacity, and the ratio of residual volume to total lung capacity, was significantly less in subjects with Caplan's syndrome. No significant differences in transfer factor were found. These findings may be explained by the different pathological features of the two entities. Selection bias does not appear to be responsible for the differences observed between the groups, but studies designed to eliminate this would be desirable.

A survey of pelvic x-rays in the elderly.

Pelvic x-rays taken as a routine in 150 patients in a geriatric hospital revealed a considerable number of pathological conditions, many of which were unexpected. These included pathollgical fractures of the pelvic bones and femoral necks, calcification of the walls of the iliac and femoral vessels, calcified fibroids of the uterus, urinary stones, arthritis of the hip joints, metastases, osteomalacia, Paget's disease of pelvic bones and lumbar vertebrae, and degenerative arthritic chcnages in the lumbar spine. Routine x-ray of the pelvis is indicated in elderly patients admitted to geriatric hospitals.